Healthcare Provider Details

I. General information

NPI: 1598976227
Provider Name (Legal Business Name): REGINA ONEAL MA LCPC LSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MERCANTILE LN 200
LARGO MD
20774-5327
US

IV. Provider business mailing address

1300 MERCANTILE LN 200
LARGO MD
20774-5327
US

V. Phone/Fax

Practice location:
  • Phone: 301-386-2991
  • Fax: 301-386-1944
Mailing address:
  • Phone: 301-386-2991
  • Fax: 301-386-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number048500400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: